Stable Angina

Question 1

What drug can be used as a preventative measure immediately before performing activities known to bring on an attack of angina?

Answer 1

Glyceryl tri-nitrate (GTN sublingually

Question 2

What beta-blockers can be used as first line therapy for the prevention of chest pain in patients with stable angina?

Answer 2

Atenolol

Bisoprolol fumarate

Metoprolol tartrate

Propranolol hydrochloride

Question 3

What type of drug should be considered if beta-blockers are contra-indicated?

Answer 3

Rate limiting calcium channel blocker.

• Verapamil hydrochloride
• Diltiazem hydrochloride

Question 4

If a beta-blocker fails to control symptoms adequately, what should be added to the treatment initially?

Answer 4

Adding a calcium channel blocker should be considered

OR

If there is intolerance to either beta-blockers or calcium channel blockers, add a long acting nitrate

Question 5

Which long acting nitrates can be used as a mono-therapy in patients who cannot tolerate beta-blockers and calcium-channel blockers?

Answer 5

Ivabradine

Nicorandil

Ranolazine

Question 6

How often should response to treatment be monitored?

Answer 6

2-4 weeks following initiation or change of drug therapy

Question 7

What lifestyle factors can be managed to help prevent cardiovascular events in patients with angina? (5)

Answer 7

Smoking cessation 
Weight management
Increased physical activity 
Psychological support 
Drug treatment

Question 8

What should all patients with stable angina due to atherosclerotic disease be prescribed?

Answer 8

• Low-dose aspirin
• Statin
• Treatment with an ACE inhibitor should be considered, particularly if the patient has diabetes